Provider Demographics
NPI:1356402028
Name:HENNING, JOLENE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:ANN
Last Name:HENNING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SPRINGBROOK LANE
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742
Mailing Address - Country:US
Mailing Address - Phone:563-659-1471
Mailing Address - Fax:
Practice Address - Street 1:629 6TH AVE
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:IA
Practice Address - Zip Code:52742
Practice Address - Country:US
Practice Address - Phone:563-659-5042
Practice Address - Fax:563-659-5044
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist